David Massicotte-Azarniouch1, Anan Bader Eddeen2, Alejandro Lazo-Langner3, Amber O Molnar4, Ngan N Lam5, Megan K McCallum6, Sarah Bota6, Deborah Zimmerman1, Amit X Garg7, Ziv Harel8, Jeffery Perl8, Ron Wald8, Manish M Sood9. 1. Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 2. Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 3. Division of Hematology, Department of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 5. Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada. 6. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 7. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada. 8. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 9. Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: msood@toh.on.ca.
Abstract
BACKGROUND: The risk for venous thromboembolism (VTE) is elevated with albuminuria or a low estimated glomerular filtration rate (eGFR). However, the VTE risk due to the combined effects of eGFR and albuminuria are unknown. STUDY DESIGN: Population-based cohort study. SETTINGS & PARTICIPANTS: 694,956 adults in Ontario, Canada, from 2002 to 2012. FACTORS: eGFR and albumin-creatinine ratio (ACR). OUTCOME: VTE. RESULTS: 15,180 (2.2%) VTE events occurred during the study period. Both albuminuria and eGFR were independently associated with VTE. The association of albuminuria and VTE differed by level of eGFR (P for ACR × eGFR interaction < 0.001). After considering the competing risk for death, there was a 61% higher rate of VTE in patients with normal eGFRs (eGFRs>90mL/min/1.73m2) and heavy albuminuria (ACR>300mg/g) compared with those with normal eGFRs and no albuminuria (subdistribution HR, 1.61; 95% CI, 1.38-1.89). Among those with reduced kidney function (eGFR, 15-29mL/min/1.73m2), the risk for VTE was only minimally increased, irrespective of albuminuria (subdistribution HRs of 1.23 [95% CI, 1-1.5] and 1.09 [95% CI, 0.82-1.45] for ACR<30 and >300mg/g, respectively). LIMITATIONS: Only single determinations of ACR and eGFR were used. Diagnostic/International Classification of Diseases codes were used to define VTE. CONCLUSIONS: Albuminuria increases the risk for VTE markedly in patients with normal eGFRs compared with those with lower eGFRs.
BACKGROUND: The risk for venous thromboembolism (VTE) is elevated with albuminuria or a low estimated glomerular filtration rate (eGFR). However, the VTE risk due to the combined effects of eGFR and albuminuria are unknown. STUDY DESIGN: Population-based cohort study. SETTINGS & PARTICIPANTS: 694,956 adults in Ontario, Canada, from 2002 to 2012. FACTORS: eGFR and albumin-creatinine ratio (ACR). OUTCOME: VTE. RESULTS: 15,180 (2.2%) VTE events occurred during the study period. Both albuminuria and eGFR were independently associated with VTE. The association of albuminuria and VTE differed by level of eGFR (P for ACR × eGFR interaction < 0.001). After considering the competing risk for death, there was a 61% higher rate of VTE in patients with normal eGFRs (eGFRs>90mL/min/1.73m2) and heavy albuminuria (ACR>300mg/g) compared with those with normal eGFRs and no albuminuria (subdistribution HR, 1.61; 95% CI, 1.38-1.89). Among those with reduced kidney function (eGFR, 15-29mL/min/1.73m2), the risk for VTE was only minimally increased, irrespective of albuminuria (subdistribution HRs of 1.23 [95% CI, 1-1.5] and 1.09 [95% CI, 0.82-1.45] for ACR<30 and >300mg/g, respectively). LIMITATIONS: Only single determinations of ACR and eGFR were used. Diagnostic/International Classification of Diseases codes were used to define VTE. CONCLUSIONS:Albuminuria increases the risk for VTE markedly in patients with normal eGFRs compared with those with lower eGFRs.
Authors: Melissa C Caughey; Vimal K Derebail; Nigel S Key; Alexander P Reiner; Rebecca F Gottesman; Abhijit V Kshirsagar; Gerardo Heiss Journal: Am J Hematol Date: 2019-09-10 Impact factor: 10.047
Authors: Valdis Ģībietis; Dana Kigitoviča; Barbara Vītola; Sintija Strautmane; Andris Skride Journal: Med Princ Pract Date: 2019-02-04 Impact factor: 1.927
Authors: Rachel Jeong; Robert R Quinn; Pietro Ravani; Feng Ye; Manish M Sood; David Massicotte-Azarniouch; Marcello Tonelli; Brenda R Hemmelgarn; Ngan N Lam Journal: Can J Kidney Health Dis Date: 2020-10-08
Authors: Ayub Akbari; Elizabeth Kunkel; Sarah E Bota; Ziv Harel; Gregoire Le Gal; Conor Cox; Gregory L Hundemer; Mark Canney; Edward Clark; David Massicotte-Azarniouch; Anan Bader Eddeen; Greg Knoll; Manish M Sood Journal: Clin Kidney J Date: 2021-01-11